Bacterial etiology of fever episodes of splenectomised patientsin three medical centers in the city of Mashhad in northeastern Iran

سال انتشار: 1401
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 76

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شناسه ملی سند علمی:

MEDISM23_615

تاریخ نمایه سازی: 16 مهر 1401

چکیده مقاله:

Background and Aim : Many medical and surgical conditions may need to be treated withsplenectomy. However, this lymphoid tissue has an important role in controlling many infections;thus, many life-threatening infections may be caused in the absence the spleen; therefore anyepisode of fever should be considered important. The aim of our study is to assess the bacterialetiology of fever episodes of splenectomised patients in three Medical centers in the city ofMashhad in northeastern Iran.Methods : In a cross-sectional study on splenectomised patients in Imam Reza, Ghaem, and Dr.Sheikh hospitals between ۲۰۰۶ and ۲۰۱۷, those with episodes of fever were included. Collecteddata included, among others, age at splenectomy, duration of hospitalization, indications for ICUadmission, recorded vital signs at admission, bacterial species causative for sepsis, times ofhospitalization due to fever episodes, clinical signs and symptoms, antibiotic prophylaxis, and ۶-month and one-year outcomes. The data was analyzed using SPSS Statistics ۲۰.Results : A total of ۲۸۰ splenectomised patients were reviewed and ۲۳ splenectomised patientswith episodes of fever were included. The most common causes of splenectomy were spleenmasses and idiopathic thrombocytopenic purpura (ITP) accounting for ۱۷.۴% of the cases, each.The mean age of patients was ۲۴.۲±۱.۶ years. ۴۷.۸% of the patients were male and ۵۲.۲% werefemale. The median admission duration was ۷ days. The most common causes of admission wereintra-abdominal infections (۲۶.۷%), pneumonia (۱۳.۳%), and bacteremia (۱۰.۰%). A total of ۳۰episodes of fever were recorded, of which ۲ (۶.۷%) ultimately ended in patient death. Blood culturewas positive in four cases (۱۳.۳%) for Streptococcus pneumoniae, Staphylococcus aureus,Citrobacter, and Brucella. Patients received suitable antibiotic coverage in ۱۳.۳% (i.e. ceftriaxone+ vancomycin or a fluoroquinolone + vancomycin), minimum suitable empiric coverage in ۱۰.۰%,and no suitable coverage in ۷۶.۷% of episodes.Conclusion : The present study highlights widespread inappropriate empiric therapy of feverepisodes in splenectomised patients as well as a lack of due attention to timely sample collectionbefore antibiotic administration. Despite this, the isolated organisms were varied and included S.pneumoniae, S. aureus, Coagulase Negative Staphylococci, P. aeruginosa, Brucella, andCitrobacter.

نویسندگان

Mahnaz Arian

Assistant Professor of Infectious Diseases and Tropical Medicine, Department of Infectious Diseases and Tropical Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Azade Haji Moniri

Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Mohammad Afkar

Emergency Medicine Specialist, Faculty of Medicine, Torbat Jam University of Medical Sciences, Torbat-e-Jam, Iran

Hossein Alavi

Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran